EHRs Need Accountable Care Features
Electronic heath records still lack the tools necessary to carry out population health management, including the ability to generate work lists, says Health IT guru Shahid Shah. Some of those missing tools might be required in stage 3 of Meaningful Use.
The Health IT Guy, in an interview with InformationWeek Healthcare.
Among these features are the ability to automate patient outreach and engagement, clinical analytics and reporting, data integration and sharing among providers, sharing of financial and billing data among disparate organizations, and the ability to generate the work lists that Shah views as essential to population health management. Work lists, which are different from registries, represent the practical tasks that care team members must perform each day to ensure that patients receive necessary care, according to Shah. Those tasks might include bringing patients in for followup, reminders about tests, or health coaching, he said.
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There are many third-party applications that provide some of these functions, often in conjunction with EHRs. But Shah told InformationWeek Healthcare that future EHRs should be able to perform them without external supplements.
For example, the leading systems today can produce reports on subgroups of patients, such as all diabetic patients with an HbA1c greater than 9. However, he said, "Population health is not just about identifying patients of a particular type, but acting on them with a variety of different work lists."
To help providers in ACOs identify care gaps and coordinate care effectively, Shah pointed out, EHRs need data from outside entities--specialists, hospitals, labs, and post-acute-care facilities--that provide care for the ACO's patients. But the government's certification criteria for EHRs "have not done a good job of helping the [EHR] companies create systems that are not going to be silos," he said.
[ Practice management software keeps the medical office running smoothly. For a closer look at KLAS' top-ranked systems, see 10 Top Medical Practice Management Software Systems. ]
Echoing a recent article by Kenneth Mandl and Isaac Kohane in the New England Journal of Medicine, Shah cited several integration methods that have been successful in other industries and that could work in healthcare. Among these are single sign-on approaches based on proven protocols such as SAML, Open ID, and OAuth. These would allow disparate systems to recognize an individual's identity so he or she doesn't need multiple logons and passwords.
The Office of the National Coordinator of Health IT (ONC), he noted, has already adopted the National Strategy for Trusted Identities in Cyberspace (NSTIC), which is defined and managed by the National Institute for Standards and Technology (NIST). NSTIC allows single sign-on of trusted entities on certain websites. Shah thinks it's possible that the government might require the same capability of EHR vendors as part of Meaningful Use Stage 3.
As for the ability to exchange data, he noted, the differences among EHR databases will remain a problem for the foreseeable future. "The vendors are not going to change their databases, and the government is not going to push that. But we need to change their thinking from assuming they're [databases] by themselves to assuming they're working with others."
Overall, Shah believes that EHRs don't include most of the population health management features listed above because "that hasn't been something that buyers have been clamoring for. But we have more sophisticated buyers coming in the next few years who will tell these EHR vendors, 'I'm not going to buy your product unless it includes these integration features.'"
Regarding the analytics applications that are available to ACOs, Shah takes issue with John Moore of Chilmark Research, who recently blogged that "analytics using clinical data is in its infancy." Although that might be true in the applications used by small physician practices, Shah said, academic medical centers and other large healthcare organizations have fairly sophisticated business intelligence software.
If anything, Shah said, the problem of assembling and analyzing clinical data for ACO purposes is smaller than the challenge of combining financial data from unrelated healthcare entities. "Over time, there will be a major problem with sharing cost data, how things are priced, and making sure that shared savings can be properly divided."
In this InformationWeek Healthcarevirtual event, EHRs: Beyond The Basics, experts will discuss how to improve electronichealth record systems. It happens July 31.